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Borkowski P, Borkowska N. Understanding Mental Health Challenges in Cardiovascular Care. Cureus 2024; 16:e54402. [PMID: 38505437 PMCID: PMC10950038 DOI: 10.7759/cureus.54402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
There is a profound link between cardiovascular health and mental well-being. This narrative review shows that heart and mental health are not isolated domains but deeply interconnected, influencing each other. It describes how cardiovascular diseases (CVDs) can cause mental health issues such as stress, anxiety, and depression. It also explains how these mental conditions can, in turn, worsen or raise the risk of CVDs. In addition, it emphasizes the necessity of a holistic approach to healthcare that integrates the treatment of physical symptoms of CVDs with interventions aimed at addressing mental health issues. This approach advocates for comprehensive care strategies that include psychotherapy, pharmacological treatments, lifestyle modifications, and digital health technologies. It also highlights the significant role of family and social support in recovery and discusses barriers to integrating mental health care in cardiovascular treatment. The article argues for a paradigm shift in healthcare towards more inclusive and integrated care models. The authors hope to foster a healthcare environment that prioritizes holistic care by increasing awareness about the connection between heart and mind. The call to action includes policy changes and healthcare system reforms aimed at facilitating the integration of mental health services into cardiovascular care, ultimately leading to improved outcomes for patients with CVDs and associated mental health issues.
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Affiliation(s)
- Pawel Borkowski
- Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA
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Nowicka M, Górska M, Edyko K, Szklarek-Kubicka M, Kazanek A, Prylińska M, Niewodniczy M, Kostka T, Kurnatowska I. Association of Physical Performance, Muscle Strength and Body Composition with Self-Assessed Quality of Life in Hemodialyzed Patients: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11092283. [PMID: 35566409 PMCID: PMC9103996 DOI: 10.3390/jcm11092283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/26/2022] [Accepted: 04/04/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Patients on chronic hemodialysis (HD) experience impaired quality of life (QoL). We analyzed HD’s relationship with physical performance, body composition, and muscle strength; (2) QoL was assessed with the Short Form-36, composed of physical (PCS) and mental (MCS) health dimensions. Physical performance was assessed with the Short Physical Performance Battery (SPPB), body composition (lean tissue mass% (LTM%), fat tissue mass% (FTM%), and skeletal muscle mass% (SMM%)) was assessed with bioelectrical impedance, and lower extremity strength was assessed with a handheld dynamometer; and (3) we enrolled 76 patients (27 F, 49 M), age 62.26 ± 12.81 years, HD vintage 28.45 (8.65−77.49) months. Their QoL score was 53.57 (41.07−70.64); their PCS and MCS scores were 52.14 (38.69−65.95) and 63.39 (44.64−76.79) and strongly correlated (p < 0.0001, R = 0.738). QoL correlated positively with SPPB (R = 0.35, p ≤ 0.001), muscle strength (R from 0.21 to 0.41, p < 0.05), and LTM% (R = 0.38, p < 0.001) and negatively with FTM% (R = −0.32, p = 0.006). PCS correlated positively with SPPB (R = 0.42 p < 0.001), muscle strength (R 0.25−0.44, p < 0.05), and LTM% (R = 0.32, p = 0.006) and negatively with FTM% (R = −0.25, p = 0.031). MCS correlated positively with SPPB (R = 0.23, p = 0.047), SMM% (R = 0.25; p = 0.003), and LTM% (R = 0.39, p < 0.001) and negatively with FTM% (R = −0.34; p = 0.003). QoL was unrelated to sex (p = 0.213), age (p = 0.157), HD vintage (p = 0.156), and BMI (p = 0.202); (4) Better physical performance, leaner body composition, and higher muscle strength are associated with better mental and physical QoL in HD.
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Affiliation(s)
- Maja Nowicka
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Monika Górska
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Krzysztof Edyko
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
| | | | - Adam Kazanek
- Therapeutic Rehabilitation Outpatient Clinic, Medical Center Lodz Baluty, 91-745 Lodz, Poland
| | - Malwina Prylińska
- Therapeutic Rehabilitation Outpatient Clinic, Medical Center Lodz Baluty, 91-745 Lodz, Poland
| | - Maciej Niewodniczy
- Rehabilitation Department, Norbert Barlicki Memorial Teaching Hospital No. 1, 90-153 Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Center, Medical University of Lodz, 90-647 Lodz, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Transplant Nephrology, Medical University of Lodz, 90-153 Lodz, Poland
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Tang LH, Andreasson KH, Thygesen LC, Jepsen R, Møller A, Skou ST. Persistent pain and long-term physical and mental conditions and their association with psychological well-being; data from 10,744 individuals from the Lolland-Falster health study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221128712. [PMID: 36386291 PMCID: PMC9659769 DOI: 10.1177/26335565221128712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Persistent pain (PP) and long-term conditions are all associated with psychological well-being. Less is known about their associations with reduced psychological well-being when co-occurring. We investigated how PP and long-term physical and mental conditions relate to psychological well-being when occurring together. METHOD Data collected in the Danish population-based Lolland-Falster Health study were used in this cross-sectional study. Participants aged ≥18 years completing questions concerning PP, long-term conditions and psychological well-being were included. PP and long-term conditions were defined as conditions lasting 6 months or longer. Psychological well-being was assessed by the World Health Organization Well-Being Index (WHO-5). Multiple linear regression investigated combinations of PP and physical and mental long-term conditions and their associations with WHO-5. RESULTS Of 11,711 participants, 10,744 had available data. One third had PP (n = 3250), while 6144 (57%), 213 (2%) and 946 (9%) reported having only physical conditions, only mental conditions or both, respectively. All combinations of PP and long-term conditions were negatively associated with WHO-5. PP in combination with mental (-23.1 (95% CI -28.3 to -17.8)) or both physical and mental conditions (-25.1 (-26.7 to -23.52) yielded the strongest negative associations. Two or more pain sites together with long-term physical and mental conditions was associated with a lower WHO-5 score (-6.2 (-8.9 to -3.5) compared to none or one pain site. CONCLUSION The presence of PP and long-term conditions, in particular mental conditions, were strongly associated with worse psychological well-being. This highlights the importance of assessing psychological well-being in individuals with PP and long-term conditions.
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Affiliation(s)
- Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Karen H Andreasson
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F., Denmark
| | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Physical Activity, Mental Health and Wellbeing during the First COVID-19 Containment in New Zealand: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212036. [PMID: 34831789 PMCID: PMC8620825 DOI: 10.3390/ijerph182212036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Strategies implemented worldwide to contain COVID-19 outbreaks varied in severity across different countries, and established a new normal for work and school life (i.e., from home) for many people, reducing opportunities for physical activity. Positive relationships of physical activity with both mental and physical health are well recognised, and therefore the aim was to ascertain how New Zealand’s lockdown restrictions impacted physical activity, mental health and wellbeing. Participants (n = 4007; mean ± SD: age 46.5 ± 14.7 years, 72% female, 80.7% New Zealand European) completed (10–26 April 2020) an online amalgamated survey (Qualtrics): International Physical Activity Questionnaire: Short Form; Depression, Anxiety and Stress Scale-9; World Health Organisation-Five Well-Being Index; Stages of Change Scale. Positive dose–response relationships between physical activity levels and wellbeing scores were demonstrated for estimates that were unadjusted (moderate activity OR 3.79, CI 2.88–4.92; high activity OR 8.04, CI 6.07–10.7) and adjusted (confounding variables: age, gender, socioeconomic status, time sitting and co-morbidities) (moderate activity 1.57, CI 1.11–2.52; high activity 2.85, CI 1.97–4.14). The study results support previous research demonstrating beneficial effects of regular physical activity on mental health and wellbeing. Governments may use these results to promote meeting physical activity guidelines in order to protect mental health and wellbeing during the ongoing COVID-19 restrictions and future pandemics.
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Tasnim R, Sujan MSH, Islam MS, Ferdous MZ, Hasan MM, Koly KN, Potenza MN. Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh. Acta Psychol (Amst) 2021; 220:103426. [PMID: 34619554 PMCID: PMC8486640 DOI: 10.1016/j.actpsy.2021.103426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh. METHODS Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively. RESULTS Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking. CONCLUSIONS Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.
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Affiliation(s)
- Rafia Tasnim
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Md Safaet Hossain Sujan
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka 1342, Bangladesh.
| | - Most Zannatul Ferdous
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh.
| | | | - Kamrun Nahar Koly
- Health System and Population Studies Division, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale School of Medicine, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA.
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Delle Donna P, Petrovic L, Nasir U, Ahmed A, Suero-Abreu GA. Phantom Shocks Associated With a Wearable Cardioverter Defibrillator. J Med Cases 2021; 12:49-53. [PMID: 34434428 PMCID: PMC8383611 DOI: 10.14740/jmc3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/07/2020] [Indexed: 11/11/2022] Open
Abstract
Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment.
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Affiliation(s)
- Paul Delle Donna
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Luka Petrovic
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Umair Nasir
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ahmed Ahmed
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Magnusson P, Mattsson G, Wallhagen M, Karlsson J. Health-related quality of life in patients with implantable cardioverter defibrillators in Sweden: a cross-sectional observational trial. BMJ Open 2021; 11:e047053. [PMID: 34244266 PMCID: PMC8273444 DOI: 10.1136/bmjopen-2020-047053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Decisions regarding implantable cardioverter defibrillators (ICDs) must consider information about presumed health-related quality of life (HRQL). The purpose of the study was to assess HRQL in patients with ICD and compare it to a Swedish age-matched and sex-matched population. DESIGN Cross-sectional observational trial. SETTING Swedish ICD cohort. INTERVENTIONS Short form 36 (SF-36) questionnaires from ICD recipients implanted 2007-2017 (response rate 77.2%) were analysed using Mann-Whitney U test and effect size (ES). RESULTS In total, 223 patients (mean age 71.1±9.7 years, 82.1% men) were included. In most SF-36 domains (physical functioning (PF), role physical, general health (GH), vitality, social functioning and mental health), the score for patients with ICD was significantly lower (ES range 0.23-0.41, ie, small difference) than norms, except for bodily pain and role emotional. Both the physical component summary (PCS) and the mental component summary (MCS) scores had ES=0.31. Men and women had similar scores. Primary and secondary prevention patients scored similarly, except for worse GH in primary prevention (p=0.016, ES=0.35). Atrial fibrillation was associated with worse PF (ES=0.41) and PCS (ES=0.38). Appropriate therapy, inappropriate shock or complications requiring surgery were not associated with lower scores in any domain. In primary prevention due to ischaemic versus non-ischaemic cardiomyopathy, no domain was significantly different. PCS decreased with higher age strata (p=0.002) in contrast to MCS (p=0.986). CONCLUSIONS Patients with ICDs have lower physical and mental HRQL than age-matched and sex-matched norms; however, the ESs are small. HRQL is similar regardless of sex, primary/secondary prevention indication, appropriate therapy, inappropriate shock or complications, but decreases with advancing age.
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Affiliation(s)
- Peter Magnusson
- Institution of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Centre for Resarch and Development Region Gävleborg, Uppsala University, Gävle, Sweden
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Gustav Mattsson
- Centre for Resarch and Development Region Gävleborg, Uppsala University, Gävle, Sweden
| | - Marita Wallhagen
- Faculty of Engineering and Sustainable Development; Department of Building, Energy and Sustainability Science, University of Gävle, Gävle, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Andersen CM, Theuns DAMJ, Johansen JB, Pedersen SS. Anxiety, depression, ventricular arrhythmias and mortality in patients with an implantable cardioverter defibrillator: 7 years' follow-up of the MIDAS cohort. Gen Hosp Psychiatry 2020; 66:154-160. [PMID: 32866884 DOI: 10.1016/j.genhosppsych.2020.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine whether anxiety and depression at time of implantation of an implantable cardioverter defibrillator (ICD) is associated with ventricular arrhythmias (VAs) and mortality 7 years later. METHODS A cohort of 399 patients (80% men; mean (SD) age = 58.3 (12.2)) implanted with an ICD completed the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory at time of implantation. Patients were followed up for VAs and mortality at 7 years. RESULTS At 7-years follow-up, 34% of the patients had died and 38% had experienced VAs. Baseline depression (score ≥ 8) (HR:2.10; 95% CI:1.44-3.05, p < 0.001) was associated with 7-year mortality in adjusted analyses while state anxiety (score ≥ 40) (HR:1.45; 95% CI:1.02-2.06, p = 0.039) and trait anxiety (score ≥ 40) (HR:1.51; 95% CI:1.06-2.16, p = 0.022) showed a trend towards an association with mortality. No association was found between VAs and anxiety and depression. There was a dose-response relationship with higher burden of anxiety (HR:2.13; 95% CI:1.31-3.46, p = 0.002) and depression (HR:2.13; 95% CI:1.33-3.42, p = 0.002) measured with the HADS (scores < 8, 8-10 and > 10) being associated with an increased risk of mortality. CONCLUSION Patients with depression had greater risk of mortality, whereas anxiety only showed a trend. Neither anxiety nor depression was associated with VAs during follow-up.
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Affiliation(s)
- Christina M Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Dominic A M J Theuns
- Department of Cardiology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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Bahall M, Legall G, Khan K. Quality of life among patients with cardiac disease: the impact of comorbid depression. Health Qual Life Outcomes 2020; 18:189. [PMID: 32552773 PMCID: PMC7302374 DOI: 10.1186/s12955-020-01433-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with cardiac disease with or without depression may also have major physical and mental problems. This study assesses and compares the quality of life (QOL) of patients with cardiac disease with and without depression and accompanying comorbidities. METHODS A cross-sectional study was conducted with a convenience sample of 388 patients with cardiac disease. The 12-item Short-Form (SF-12)-patient was used to measure physical component scale (PCS) and mental component scale (MCS) QOL, and the Patient Health Questionnaire (PHQ-9) was used to measure depression. The Charlson Comorbidity Index was used to estimate 10-year survival probability. Descriptive statistics, analysis of covariance (ANCOVA), chi-square tests, and binary logistic regression were used for analysis. RESULTS The prevalence of minimal to mild depression was 65.7% [(95% CI (60.8, 70.4)] and that of moderate to severe depression was 34.3% [95% CI (29.6, 39.2)]. There was no significant association between the level of PHQ-categorised depression and age (p = 0.171), sex (p = 0.079), or ethnicity (p = 0.407). The overall mean PCS and MCS QOL was 32.5 [95% CI (24.4, 40.64)] and 45.4 [95% CI (44.4, 46.4)], respectively, with no significant correlation between PCS and MCS [r (Pearson's) = 0.011; p = 0.830)]. There were QOL differences among the five PHQ categories (PCS: p = 0.028; MCS: p ≤ 0.001) with both MCS and PCS decreasing with increasing depression. ANCOVA (with number of comorbidities as the covariate) showed a significant age × ethnicity interaction for PCS (p = 0.044) and MCS (p = 0.039), respectively. Young Indo-Trinidadians had significantly lower PCS than did Afro-Trinidadians, while the converse was true for MCS. Depression, age, and number of comorbidities were predictors of PCS, while depression, age, and sex were predictors of MCS. CONCLUSIONS Increasing severity of depression worsened both PCS and MCS QOL. Age and level of clinical depression predicted QOL, with number of comorbidities predicting only PCS and sex predicting only MCS. Efforts must be made to treat depression in all age groups of patients with cardiac disease.
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Affiliation(s)
- Mandreker Bahall
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Mt Hope, House #57 LP 62, Calcutta Road Number 3, Mc Bean, Couva, Trinidad, Trinidad and Tobago.
| | - George Legall
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Mt Hope, House #57 LP 62, Calcutta Road Number 3, Mc Bean, Couva, Trinidad, Trinidad and Tobago
| | - Katija Khan
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Mt Hope, House #57 LP 62, Calcutta Road Number 3, Mc Bean, Couva, Trinidad, Trinidad and Tobago
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Amin MM, Witt CM, Waks JW, Mehta RA, Friedman PA, Kramer DB, Buxton AE, Mulpuru SK, Hodge DO, Frey RJ, Frederick NK, Cha YM, Brenes-Salazar J, Madhavan M. Association between the Charlson comorbidity index and outcomes after implantable cardioverter defibrillator generator replacement. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1236-1242. [PMID: 31355952 DOI: 10.1111/pace.13762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recipients of implantable cardioverter defibrillator (ICD) generator replacement with multiple medical comorbidities may be at higher risk of adverse outcomes that attenuate the benefit of ICD replacement. The aim of this investigation was to study the association between the Charlson comorbidity index (CCI) and outcomes after ICD generator replacement. METHODS All patients undergoing first ICD generator replacement at Mayo Clinic, Rochester and Beth Israel Deaconess Medical Center, Boston between 2001 and 2011 were identified. Outcomes included: (a) all-cause mortality, (b) appropriate ICD therapy, and (c) death prior to appropriate therapy. Multivariable Cox regression analysis was performed to assess association between CCI and outcomes. RESULTS We identified 1421 patients with mean age of 69.6 ± 12.1 years, 81% male and median (range) CCI of 3 (0-18). During a mean follow-up of 3.9 ± 3 years, 52% of patients died, 30.6% experienced an appropriate therapy, and 23.6% died without experiencing an appropriate therapy. In multivariable analysis, higher CCI score was associated with increased all-cause mortality (Hazard ratio, HR 1.10 [1.06-1.13] per 1 point increase in CCI, P < .001), death without prior appropriate therapy (HR 1.11 [1.07-1.15], P < .0001), but not associated with appropriate therapy (HR 1.01 [0.97-1.05], P = .53). Patients with CCI ≥5 had an annual risk of death of 12.2% compared to 8.7% annual rate of appropriate therapy. CONCLUSIONS CCI is predictive of mortality following ICD generator replacement. The benefit of ICD replacement in patients with CCI score ≥5 should be investigated in prospective studies.
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Affiliation(s)
- Mustapha M Amin
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Chance M Witt
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jonathan W Waks
- Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ramila A Mehta
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Daniel B Kramer
- Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Alfred E Buxton
- Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Rebecca J Frey
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Malini Madhavan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Miller JL, Thylén I, Elayi SC, Etaee F, Fleming S, Czarapata MM, Lennie TA, Moser DK. Multi-morbidity burden, psychological distress, and quality of life in implantable cardioverter defibrillator recipients: Results from a nationwide study. J Psychosom Res 2019; 120:39-45. [PMID: 30929706 DOI: 10.1016/j.jpsychores.2019.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence of multi-morbidity in implantable cardioverter defibrillator (ICD) recipients is approximately 25%. Multi-morbidity is associated with poor health and psychological outcomes in this population and may affect ICD recipients' quality-of-life (QOL). The purpose of this study was to determine the prevalence of psychological distress (anxiety, depressive symptoms, and Type-D personality) in ICD recipients with varying levels of comorbidities, and to examine the association between multi-morbidity burden and QOL in this population. METHODS All adults listed in the Swedish ICD and Pacemaker Registry in 2012 with an ICD implanted for at least one year were invited to participate in this study. Binary logistic regression was used to predict QOL using the EQ-5D mean index dichotomized based on median QOL scores. Multi-morbidity burden scores were based on quartile groupings. RESULTS A total of 2658 ICD recipients participated in the study (with a mean age of 65, 20.6% female, mean implant duration of 4.7 years, with 35.4% implanted for primary prevention of sudden cardiac arrest). Greater multi-morbidity burden, female sex, not working outside the home, history of ICD shock, negative ICD experience, higher levels of ICD-related concerns, and the presence of anxiety, depression, or Type D personality were associated with worse QOL in ICD recipients. Predictors differed by multi-morbidity burden level. CONCLUSIONS Multi-morbidity burden and psychological distress is an essential factor related to QOL. This issue should be discussed with potential ICD recipients prior to implant. Further exploration of increased recognition and treatment of psychological distress in ICD recipients is warranted.
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Affiliation(s)
- Jennifer L Miller
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| | - Ingela Thylén
- Department of Cardiology, Department of Medical Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Samy C Elayi
- University of Florida, Jacksonville, FL, United States
| | - Farshid Etaee
- Division of Cardiology, University of Kentucky College of Medicine, Gill Heart Institute, 800 Rose St, Lexington, KY 40536, United States.
| | - Steve Fleming
- University of Kentucky College of Public Health, Lexington, KY, United States
| | - Mary M Czarapata
- Division of Cardiology, University of Kentucky College of Medicine, Gill Heart Institute, 800 Rose St, Lexington, KY 40536, United States
| | - Terry A Lennie
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| | - Debra K Moser
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
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12
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Patient-Reported Quality of Life as a Predictor of Mortality and Ventricular Tachyarrhythmia's During 7 Years' Follow-Up in Patients With an Implantable Cardioverter Defibrillator (from the MIDAS Study). Am J Cardiol 2019; 123:605-610. [PMID: 30553508 DOI: 10.1016/j.amjcard.2018.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
Preliminary evidence suggests that poor patient-reported quality of life (QoL) predicts mortality on the short term in patients with an implantable cardioverter defibrillator (ICD). It is unclear if this association persists on the long term. We evaluated whether patient-reported QoL at the time of implantation predicts mortality and ventricular tachyarrhythmias (VTa's) during 7 years' follow-up in patients with an ICD. A consecutive cohort of patients (80% men; mean [SD] age = 58 [12]) implanted with an ICD completed the Short Form Health Survey (SF-36). The 8 SF-36 subscales and the 2 component summary scores were used as predictors of VTa's and mortality at 7 years' follow-up. At 7 years' follow-up, 34% (132/392) of patients had died. Baseline physical functioning (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.11 to 2.29), role physical functioning (HR: 1.59; 95% CI: 1.09 to 2.31), vitality (HR: 1.53; 95% CI: 1.05 to 2.22), and general health (HR: 1.57; 95% CI: 1.09 to 2.27) were associated with 7-year mortality in adjusted analyses. There was a trend for low mental health being associated with an increased risk of mortality (HR: 1.38; 95% CI: 0.98 to 1.96). The other SF-36 dimensions were not significantly associated with mortality. Only baseline social functioning was associated with risk of VTa's during follow-up. In conclusion, patients with lower levels of physical functioning, role physical functioning, vitality, or general health had a greater risk of mortality, whereas only poor social functioning was associated with VTa's during 7 years' follow-up. Patient-reported QoL at the time of implant could be used to identify patients at risk for long-term mortality.
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13
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Pedersen SS, Knudsen C, Dilling K, Sandgaard NCF, Johansen JB. Living with an implantable cardioverter defibrillator: patients' preferences and needs for information provision and care options. Europace 2018; 19:983-990. [PMID: 27267553 DOI: 10.1093/europace/euw109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The clinical management and care of patients with an implantable cardioverter defibrillator (ICD) has shifted from face-to-face in-clinic visits to remote monitoring. Reduced interactions between patients and healthcare professionals may impede patients' transition to adapting post-implant. We examined patients' needs and preferences for information provision and care options and overall satisfaction with treatment. Methods and results Patients implanted with a first-time ICD or defibrillator with cardiac resynchronization therapy (n = 389) within the last 2 years at Odense University Hospital were asked to complete a purpose-designed and standardized set of questionnaires. The level of satisfaction with information provision was high; only 13.1% were dissatisfied. Psychological support for patients (39.9%), their relatives (43.1%), and deactivation of the ICD towards end of life (47.8%) were among the top five topics that patients reported to have received no information about. The top five care options that patients had missed were talking to the same healthcare professional (75.2%), receiving ongoing feedback via remote monitoring (61.1%), having a personal conversation with a staff member 2-3 weeks post-implant (59.6%), having an exercise tolerance test (52.5%), and staff asking how patients felt while hospitalized (50.4%). Patients with a secondary prevention indication and cardiac arrest survivors had specific needs, including a wish for a psychological consult post-discharge. Conclusion Despite a high satisfaction level with information provision, particular topics are not broached with patients (e.g. device activation) and patients have unmet needs that are not met in current clinical practice.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Charlotte Knudsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Karen Dilling
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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14
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Carvalho FG, de Souza CM, Hidalgo MPL. Work routines moderate the association between eveningness and poor psychological well-being. PLoS One 2018; 13:e0195078. [PMID: 29624593 PMCID: PMC5889056 DOI: 10.1371/journal.pone.0195078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 03/17/2018] [Indexed: 11/19/2022] Open
Abstract
Well-being is a useful screening method for the detection of mood disorders. Evidence associating psychological well-being with sleep-wake patterns exists, as well as associations with sleep-wake patterns, work-related parameters, and perceived self-efficacy. Despite the growing research regarding the relationship between these factors and mental health, there are few studies that analyze them together. OBJECTIVE: To investigate if the association between sleep-wake patterns and psychological well-being is mediated or moderated by perceived self-efficacy, work flexibility and work routines. MATERIAL AND METHODS: This cohort study was performed in southern Brazil. A sample of 987 individuals was analyzed (66.9% women; mean age = 43.9 years). Work routines parameters and work schedule flexibility were evaluated, most participants were farmers (46%) and most worked 7 days a week (69.1%). Munich Chronotype Questionnaire (MCTQ) was administered for evaluation of sleep-wake patterns, General Self-Efficacy Scale (GSE) for assessment the participants’ beliefs about how they coped with daily hassles, and World Health Organization Five-item Well-being Index (WHO-5) for evaluation of psychological well-being levels. Moderation and mediation models were tested. RESULTS: The moderation model showed influences of work end time on the relationship between sleep onset time and psychological well-being (R2 = 0.147; F = 24.16; p<0.001). The final regression model showed an association of psychological well-being with sex (Beta = -0.086; p = 0.004), sleep onset time (Beta = -0.086; p = 0.006), and self-efficacy (Beta = 0.316; p<0.001); the work end time showed association in the interaction with sleep onset time (Beta = -0.075; p = 0.016). CONCLUSION: The findings support the direct association of psychological well-being with sleep-wake patterns and self-efficacy, and show an interaction between work routines and sleep-wake patterns. Our results draw attention to the importance of the interplay between individual and social rhythms in relation to psychological well-being.
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Affiliation(s)
- Felipe Gutiérrez Carvalho
- Chronobiology and Sleep Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre- RS, Brazil
- Psychiatry and Behavior Sciences Post-Graduation Program, Universidade Federal do Rio Grande do Sul, Porto Alegre- RS, Brazil
- * E-mail:
| | - Camila Morelatto de Souza
- Chronobiology and Sleep Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre- RS, Brazil
- Psychiatry and Behavior Sciences Post-Graduation Program, Universidade Federal do Rio Grande do Sul, Porto Alegre- RS, Brazil
| | - Maria Paz Loayza Hidalgo
- Chronobiology and Sleep Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre- RS, Brazil
- Psychiatry and Behavior Sciences Post-Graduation Program, Universidade Federal do Rio Grande do Sul, Porto Alegre- RS, Brazil
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Magnusson P, Jonsson J, Mörner S, Fredriksson L. Living with hypertrophic cardiomyopathy and an implantable defibrillator. BMC Cardiovasc Disord 2017; 17:121. [PMID: 28490380 PMCID: PMC5424404 DOI: 10.1186/s12872-017-0553-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ICDs efficiently terminate life-threatening arrhythmias, but complications occur during long-term follow-up. Patients' own perspective is largely unknown. The aim of the study was to describe experiences of hypertrophic cardiomyopathy (HCM) patients with implantable defibrillators (ICDs). METHODS We analyzed 26 Swedish patient interviews using hermeneutics and latent content analysis. RESULTS Patients (aged 27-76 years) were limited by HCM especially if it deteriorates into heart failure. The ICD implies safety, gratitude, and is accepted as a part of the body even when inappropriate ICD shocks are encountered. Nobody regretted the implant. Both the disease and the ICD affected professional life and leisure time activities, especially at younger ages. Family support was usually strong, but sometimes resulted in overprotection, whereas health care focused on medical issues. Despite limitations, patients adapted, accepted, and managed challenges. CONCLUSION HCM patients with ICDs reported good spirit and hope even though they had to adapt and accept limitations over time.
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Affiliation(s)
- Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital/Solna, SE-171 76, Stockholm, Sweden. .,Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87, Gävle, Sweden.
| | - Jessica Jonsson
- Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87, Gävle, Sweden
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, SE-90187, Umeå, Sweden
| | - Lennart Fredriksson
- Centre for Research and Development, Uppsala University/Region Gävleborg, SE-801 87, Gävle, Sweden
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16
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Standing H, Exley C, Flynn D, Hughes J, Joyce K, Lobban T, Lord S, Matlock D, McComb JM, Paes P, Thomson RG. A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background
Implantable cardioverter defibrillators (ICDs) are recommended for patients at high risk of sudden cardiac death or for survivors of cardiac arrest. All ICDs combine a shock function with a pacing function to treat fast and slow heart rhythms, respectively. The pacing function may be very sophisticated and can provide so-called cardiac resynchronisation therapy for the treatment of heart failure using a pacemaker (cardiac resynchronisation therapy with pacemaker) or combined with an ICD [cardiac resynchronisation therapy with defibrillator (CRT-D)]. Decision-making about these devices involves considering the benefit (averting sudden cardiac death), possible risks (inappropriate shocks and psychological problems) and the potential need for deactivation towards the end of life.
Objectives
To explore patients’/relatives’ and clinicians’ views/experiences of decision-making about ICD and CRT-D implantation and deactivation, to establish how and when ICD risks, benefits and consequences are communicated to patients, to identify individual and organisational facilitators and barriers to discussions about implantation and deactivation and to determine information and decision-support needs for shared decision-making (SDM).
Data sources
Observations of clinical encounters, in-depth interviews and interactive group workshops with clinicians, patients and their relatives.
Methods
Observations of consultations with patients being considered for ICD or CRT-D implantation were undertaken to become familiar with the clinical environment and to optimise the sampling strategy. In-depth interviews were conducted with patients, relatives and clinicians to gain detailed insights into their views and experiences. Data collection and analysis occurred concurrently. Interactive workshops with clinicians and patients/relatives were used to validate our findings and to explore how these could be used to support better SDM.
Results
We conducted 38 observations of clinical encounters, 80 interviews (44 patients/relatives, seven bereaved relatives and 29 clinicians) and two workshops with 11 clinicians and 11 patients/relatives. Patients had variable knowledge about their conditions, the risk of sudden cardiac death and the clinical rationale for ICDs, which sometimes resulted in confusion about the potential benefits. Clinicians used various metaphors, verbal descriptors and numerical risk methods, including variable disclosure of the potential negative impact of ICDs on body image and the risk of psychological problems, to convey information to patients/relatives. Patients/relatives wanted more information about, and more involvement in, deactivation decisions, and expressed a preference that these decisions be addressed at the time of implantation. There was no consensus among clinicians about the initiation or timing of such discussions, or who should take responsibility for them. Introducing deactivation discussions prior to implantation was thus contentious; however, trigger points for deactivation discussions embedded within the pathway were suggested to ensure timely discussions.
Limitations
Only two patients who were prospectively considering deactivation and seven bereaved relatives were recruited. The study also lacks the perspectives of primary care clinicians.
Conclusions
There is discordance between patients and clinicians on information requirements, in particular the potential consequences of implantation on psychological well-being and quality of life in the short and long term (deactivation). There were no agreed points across the care pathway at which to discuss deactivation. Codesigned information tools that present balanced information on the benefits, risks and consequences, and SDM skills training for patients/relative and clinicians, would support better SDM about ICDs.
Future work
Multifaceted SDM interventions that focus on skills development for SDM combined with decision-support tools are warranted, and there is a potential central role for heart failure nurses and physiologists in supporting and preparing patients/relatives for such discussions.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Holly Standing
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Julian Hughes
- Policy, Ethics and Life Sciences Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Kerry Joyce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Trudie Lobban
- Arrhythmia Alliance: The Heart Rhythm Charity, Stratford-upon-Avon, UK
| | - Stephen Lord
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janet M McComb
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Richard G Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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17
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Kao CW, Chen MY, Chen TY, Lin PH. Effect of psycho-educational interventions on quality of life in patients with implantable cardioverter defibrillators: a meta-analysis of randomized controlled trials. Health Qual Life Outcomes 2016; 14:138. [PMID: 27716219 PMCID: PMC5045654 DOI: 10.1186/s12955-016-0543-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 09/27/2016] [Indexed: 01/22/2023] Open
Abstract
Background Implantable cardioverter defibrillators (ICD) were developed for primary and secondary prevention of sudden cardiac death. However, ICD recipients’ mortality is significantly predicted by their quality of life (QOL). The aim of this meta-analysis was to evaluate the effects of psycho-educational interventions on QOL in patients with ICDs. Methods We systematically searched PubMed, Medline, Cochrane Library, and CINAHL through April 2015 and references of relevant articles. Studies were reviewed if they met following criteria: (1) randomized controlled trial, (2) participants were adults with an ICD, and (3) data were sufficient to evaluate the effect of psychological or educational interventions on QOL measured by the SF-36 or SF-12. Studies were independently selected and their data were extracted by two reviewers. Study quality was evaluated using a modified Jadad scale. The meta-analysis was conducted using the Cochrane Collaboration’s Review Manager Software Package (RevMan 5). Study heterogeneity was assessed by Q statistics and I2 statistic. Depending on heterogeneity, data were pooled across trials using fixed-effect or random-effect modeling. Results Seven randomized controlled trials fulfilled the inclusion and exclusion criteria, and included 1017 participants. The psycho-educational interventions improved physical component summary (PCS) scores in the intervention groups more than in control groups (mean difference 2.08, 95 % CI 0.86 to 3.29, p < 0.001), but did not significantly affect mental component summary (MCS) scores (mean difference 0.84, 95 % CI -1.68 to 3.35, p = 0.52). Conclusion Our meta-analysis demonstrates that psycho-educational interventions improved the physical component, but not the mental component of QOL in patients with ICDs.
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Affiliation(s)
- Chi-Wen Kao
- Department of Nursing, Tri-Service General Hospital, No.325, Sec.2, Chenggong Rd., Taipei, 114, Taiwan. .,National Defense Medical Center, School of Nursing, No.161, Minchuan E. RD., Sec. 6, Taipei, 114, Taiwan.
| | - Miao-Yi Chen
- Department of Nursing, Ching Kuo Institute of Management and Health, No.336, Fu Hsin Rd., Keelung, Taiwan
| | - Ting-Yu Chen
- National Defense Medical Center, School of Nursing, No.161, Minchuan E. RD., Sec. 6, Taipei, 114, Taiwan.,Chung-Jen College of Nursing, Health Sciences and Management, No.161, Minchuan E. RD., Sec. 6, Taipei, 114, Taiwan
| | - Pai-Hui Lin
- Department of Nursing, Tri-Service General Hospital, No.325, Sec.2, Chenggong Rd., Taipei, 114, Taiwan
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PEDERSEN SUSANNES, NIELSEN JENSCOSEDIS, RIAHI SAM, HAARBO JENS, VidebAEk R, LARSEN MOGENSLYTKEN, SKOV OLE, KNUDSEN CHARLOTTE, JOHANSEN JENSBROCK. Study Design and Cohort Description of DEFIB-WOMEN: A National Danish Study in Patients with an ICD. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1261-1268. [DOI: 10.1111/pace.12942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- SUSANNE S. PEDERSEN
- Department of Psychology; University of Southern Denmark; Odense Denmark
- Department of Cardiology; Odense University Hospital; Odense Denmark
- Department of Cardiology; Erasmus Medical Center; Rotterdam the Netherlands
| | | | - SAM RIAHI
- Department of Cardiology; Aalborg University Hospital; Aalborg Denmark
| | - JENS HAARBO
- Department of Cardiology, Gentofte Hospital; Copenhagen University Hospital; Copenhagen Denmark
| | - Regitze VidebAEk
- Department of Cardiology, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | | | - OLE SKOV
- Department of Psychology; University of Southern Denmark; Odense Denmark
| | - CHARLOTTE KNUDSEN
- Department of Psychology; University of Southern Denmark; Odense Denmark
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19
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Magnusson P, Mörner S, Gadler F, Karlsson J. Health-related quality of life in hypertrophic cardiomyopathy patients with implantable defibrillators. Health Qual Life Outcomes 2016; 14:62. [PMID: 27079917 PMCID: PMC4832478 DOI: 10.1186/s12955-016-0467-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/08/2016] [Indexed: 01/18/2023] Open
Abstract
Background Health-related quality of life (HRQL) in hypertrophic cardiomyopathy (HCM) patients with implantable cardioverter-defibrillators (ICDs) is largely unknown. The aim was to assess HRQL, including comparisons between groups, using the questionnaire SF-36, and compare it to a Swedish age- and sex-matched population. Methods and Results Validated data on adult HCM patients with ICDs were used. The SF-36 response rate was 82.5 % and 245 patients (mean age 55.9 years, 70.2 % men) were analyzed using the Mann-Whitney U-test, t-test, Spearman correlation and effect size calculations. In all SF-36 domains the patients’ score was lower (p-value of <0.0001) than norms except for bodily pain. The general health domain showed the highest effect size (0.77) and the impact was more pronounced in the SF-36 physical component summary score (0.62) than the mental component summary score (0.46). Older age was correlated with lower scores on the physical component and higher scores on the mental component. Atrial fibrillation and/or systolic heart failure were associated with worse physical health. HRQL was similar in primary vs secondary prevention cases. Inappropriate ICD shock was associated with worse mental health while appropriate therapy trended toward better mental health. Conclusion HCM patients with ICDs suffer from poor HRQL regardless of age, sex, or primary vs secondary prevention indication. Atrial fibrillation and systolic heart failure are determinants of poor physical health. Inappropriate shocks, but not appropriate therapies, are associated with poorer mental health.
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Affiliation(s)
- Peter Magnusson
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital/Solna, Stockholm, SE-171 76, Sweden. .,Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, SE-801 87, Sweden.
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE-90187, Sweden
| | - Fredrik Gadler
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital/Solna, Stockholm, SE-171 76, Sweden
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-70182, Örebro, Sweden
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20
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Thylén I, Moser DK, Strömberg A, Dekker RA, Chung ML. Concerns about implantable cardioverter-defibrillator shocks mediate the relationship between actual shocks and psychological distress. Europace 2015; 18:828-35. [PMID: 26324839 DOI: 10.1093/europace/euv220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/15/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Although most implantable cardioverter-defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not yet been investigated. Our objective was to examine whether the relationship between receipt of defibrillating shocks and psychological distress was mediated by patients' concerns related to their ICD. METHODS AND RESULTS All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3067 completing the survey (55% response rate). Their mean age was 66 ± 11 years, and 80% were male. One-third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression [odds ratio (OR) 1.58 and OR 3.04, respectively]. The association between receipt of shocks and psychologically distress was mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety, and 54% of the relationship between shocks and symptoms of depression. CONCLUSION Implantable cardioverter-defibrillator-related concerns have a bigger impact on psychological distress than receipt of an actual shock. Assessing ICD-related concerns in clinical practice can identify patients at risk for psychological distress. Further research on assessment of, and interventions targeting, ICD-related concerns is warranted.
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Affiliation(s)
- Ingela Thylén
- Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Debra K Moser
- College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA University of Ulster, Newtownabbey, UK
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Rebecca A Dekker
- College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
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21
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Lane DA, Aguinaga L, Blomström-Lundqvist C, Boriani G, Dan GA, Hills MT, Hylek EM, LaHaye SA, Lip GYH, Lobban T, Mandrola J, McCabe PJ, Pedersen SS, Pisters R, Stewart S, Wood K, Potpara TS, Gorenek B, Conti JB, Keegan R, Power S, Hendriks J, Ritter P, Calkins H, Violi F, Hurwitz J. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015; 17:1747-69. [PMID: 26108807 DOI: 10.1093/europace/euv233] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Mastenbroek MH, Denollet J, Versteeg H, van den Broek KC, Theuns DA, Meine M, Zijlstra WP, Pedersen SS. Trajectories of patient-reported health status in patients with an implantable cardioverter defibrillator. Am J Cardiol 2015; 115:771-7. [PMID: 25623734 DOI: 10.1016/j.amjcard.2014.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
To date, no study has assessed the course of patient-reported health status in patients with an implantable cardioverter defibrillator (ICD). Studying health status trajectories and their baseline determinants would permit the identification of patients at risk for poor health outcomes after ICD implantation. A combined cohort of 1,222 patients with an ICD (79% men; age = 61.4 [11.2] years) completed the 12-Item Short-Form Health Survey at baseline and 2 to 3 months and 12 to 14 months after implantation. Latent class analyses were used to identify trajectories and predictors of health status over time. Most health status trajectories showed a stable pattern after short-term follow-up, with differences between trajectories being mainly related to differences in absolute levels of health status. Seven trajectories were identified for physical health status. Being unemployed, symptomatic heart failure, ICD shock, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer physical health status. For mental health status, 6 trajectories were identified. Younger age, low educational level, symptomatic heart failure, renal failure, no use of ACE inhibitors, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer mental health status. In conclusion, the population with an ICD seems to be heterogeneous in terms of patient-reported physical and mental health status. Patients with an ICD who present with poor health status and a distressed personality profile should be timely identified and monitored as they may benefit from cardiac rehabilitation in combination with behavioral intervention.
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Sears SF, Whited A, Koehler J, Gunderson B. Examination of the differential impacts of antitachycardia pacing vs. shock on patient activity in the EMPIRIC study. Europace 2015; 17:417-23. [PMID: 25600766 DOI: 10.1093/europace/euu305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Implantable cardioverter defibrillators (ICDs) have demonstrated mortality advantages over antiarrhythmic drug therapy, but ICD shock has known detrimental effects on quality of life and psychologic functioning. However, it remains unknown how patient activity level is affected by shock, or by antitachycardia pacing (ATP), which was developed to reduce the treatment burden of shocks. Examine the differential impact of ICD shock and ATP on patient activity level as a novel way to capture the relative behavioural repercussions of these ICD therapies. METHODS AND RESULTS Accelerometer-derived activity data were analysed for a subset of patients (males = 83%; mean age = 62 years) enrolled in the EMPIRIC trial who received shock (n = 71) or ATP (n = 103). Differences in activity between a week pre-therapy and a week post-therapy were examined to assess the behavioural repercussions of shock vs. ATP when one, few (2-4), or many (5+) therapies were delivered. For patients receiving shock, a significant reduction in activity was observed for few (-26%) and many shocks (-34%) in the first week post-therapy (P < 0.05). In weeks 2-4, activity levels recovered towards baseline levels. In contrast, no level of ATP-only therapy significantly reduced patients' activity levels at any time following therapy. CONCLUSION This study is the first to evaluate objective, behavioural effects of shock, and whether these effects are comparable with ATP therapy alone. In tandem with existing literature, current results highlight that ICD shocks and ATP have divergent effects on behavioural outcomes, with ATP's effect profile in these domains appearing somewhat favourable.
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Affiliation(s)
- Samuel F Sears
- Department of Psychology, East Carolina University, 104 Rawl Building, East 5th Street, Greenville, NC 27858, USA Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Amanda Whited
- Department of Psychology, East Carolina University, 104 Rawl Building, East 5th Street, Greenville, NC 27858, USA Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Jodi Koehler
- Medtronic, Inc., 8200 Coral Sea St NE, Moundsview, MN 55112, USA
| | - Bruce Gunderson
- Medtronic, Inc., 8200 Coral Sea St NE, Moundsview, MN 55112, USA
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Calvagna GM, Torrisi G, Giuffrida C, Patanè S. Pacemaker, implantable cardioverter defibrillator, CRT, CRT-D, psychological difficulties and quality of life. Int J Cardiol 2014; 174:378-80. [DOI: 10.1016/j.ijcard.2014.03.187] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/29/2014] [Indexed: 11/15/2022]
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Habibović M, Pedersen SS, van den Broek KC, Denollet J. Monitoring treatment expectations in patients with an implantable cardioverter-defibrillator using the EXPECT-ICD scale. Europace 2014; 16:1022-7. [PMID: 24596397 DOI: 10.1093/europace/euu006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Patient treatment expectations may affect cardiac outcomes; however, till date, no validated instruments have been developed to monitor treatment expectations in patients with an implantable cardioverter-defibrillator (ICD). This study evaluates the predictive value of the newly developed 10-item EXPECtations Towards ICD therapy (EXPECT-ICD) in relation to anxiety, depression, and ICD related concerns 3 months post-implant. METHODS AND RESULTS Consecutive implanted ICD patients were included as part of the WEB-based distress management programme for ICD patients (WEBCARE) trial from six Dutch referral hospitals. The patients completed the baseline questionnaires briefly after ICD implantation. Information on clinical variables was captured from the patients' medical records. Patients' treatment expectations as assessed with the EXPECT-ICD questionnaire could best be represented with a two-factor model involving both negative (α = 0.84) and positive expectations (α = 0.77) with a score range of 0-20 for each factor. Negative treatment expectations were associated with higher levels of anxiety (β = 0.443; P < 0.001), depression (β = 0.506; P < 0.001), and ICD concerns (β = 0.428; P < 0.001) 3 months post-implant after controlling for demographic and clinical factors. Positive expectations were not related to any of the distress outcomes. CONCLUSION Negative expectations were associated with anxiety, depression, and ICD concerns 3 months post-implant. The current findings indicate that the EXPECT-ICD scale is a reliable, valid, and disease-specific measure of the treatment expectations in ICD patients. Future research needs to investigate whether addressing the patients' expectations might improve the outcome and the subjective well-being of ICD patients.
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Affiliation(s)
- Mirela Habibović
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands
| | - Susanne S Pedersen
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 2040, 3000 CA Rotterdam, The Netherlands Department of Psychology, University of Southern Denmark, DK-5230 Odense, Denmark Department of Cardiology, Odense University Hospital, DK-5000 Odense, Denmark
| | - Krista C van den Broek
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands
| | - Johan Denollet
- CoRPS-Department of Medical and Clinical Psychology, Tilburg University, 90153, 5000 LE Tilburg, The Netherlands
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STARRENBURG ANNEMIEKE, PEDERSEN SUSANNE, van den BROEK KRISTA, KRAAIER KARIN, SCHOLTEN MARCOEN, VAN DER PALEN JOB. Gender Differences in Psychological Distress and Quality of Life in Patients with an ICD 1-Year Postimplant. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:843-52. [DOI: 10.1111/pace.12357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/19/2013] [Accepted: 12/29/2013] [Indexed: 11/27/2022]
Affiliation(s)
- ANNEMIEKE STARRENBURG
- Department of Clinical Psychology; Medisch Spectrum Twente; Enschede the Netherlands
| | - SUSANNE PEDERSEN
- CoRPS-Center of Research on Psychology in Somatic diseases; Tilburg University; Tilburg the Netherlands
- Department of Cardiology; Thoraxcentre; Erasmus Medical Centre; Rotterdam the Netherlands
| | - KRISTA van den BROEK
- CoRPS-Center of Research on Psychology in Somatic diseases; Tilburg University; Tilburg the Netherlands
| | - KARIN KRAAIER
- Department of Cardiology, Thorax Center Twente; Medisch Spectrum Twente; Enschede the Netherlands
| | - MARCOEN SCHOLTEN
- Department of Cardiology, Thorax Center Twente; Medisch Spectrum Twente; Enschede the Netherlands
| | - JOB VAN DER PALEN
- Department of Research Methodology; Measurement and Data Analyses; University of Twente; Enschede the Netherlands
- Medical School Twente; Medisch Spectrum Twente; Enschede the Netherlands
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